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Lysodren Patient Assistance Programs

Lysodren: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Lysodren. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Insurance Status
Must have no prescription coverage for needed medication

Those with Part D Elibible?
Yes, but contact program for details

Income
At or below 300% of FPL

Diagnosis/Medical Criteria
FDA-approved diagnosis

U.S. Residency Required?
The patient must reside in the US, Puerto Rico or the USVI.

Application

Obtaining
Call or download

Receiving
Faxed

Returning
The completed application should be faxed back from the doctor's office.

Doctor's Action
Complete section, sign, attach required documents

Applicant's Action
Complete section, sign, attach proof of income and any insurance information

Decision Communicated
Doctor notified

Decision Timeframe
Not specified

Medication

Amount/Supply
Not specified

Sent To
Doctor's office

Delivery Time
Not specified

Refill Proces
Doctor/Doctor's office must contact company

Limit
Not specified

Re-application
New application yearly

Additional Information

This program is intended for US HEALTHCARE PROFESSIONALS and/or Professionals involved in Healthcare Reimbursement ONLY.
Medicare Part D enrollees may apply for assistance through a case by case appeals process based on significant financial and medical need. Those receiving Medicare Part D LIS are not eligible. Contact program for details.
*This program provides the screening for the Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF) Oncology Patient Assistance Program.
This program also provides copay assistance.

Updated September 26, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

Doctor's Action
Will be discussed with patient and Doctor after request is received

Applicant's Action
Call for information or inform doctor that he/she is in need

Decision Communicated
Patient and Doctor notified in writing

Decision Timeframe
Within 48 hours

Medication

Amount/Supply
Not applicable

Sent To
Patient sent card to be used at pharmacy

Delivery Time
Once approved; shipped same day

Refill Proces
Patient presents voucher/card to pharmacy for each refill

Limit
None

Re-application
New application every 12 months

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated July 10, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.